Homestead_Belcher (2) •
'TALE FORM!3w du,...) nrwwtLl POEM TS-IA
APPROVED BY AgL BOW)M MVYR EN1 C.yw PEGV(Rtam BY nit DEPARTe.1{f LOCAL GOVER MrNT FINANCE IC 1.1.1-2:4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 individuals and married couple.are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than etcr for homestead fraud homestead fraud causer higher tax bills for all:therefore.
HEA 1347-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receie the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kept conlidentinl and can only be accessed by atehorired county officials The Ikpanaent of
Local Government Finance will hiss this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY L\FORMATION
Taipaver Name Property Address
Belcher, !key R/Kathy
Old US 41
__ ,—_ _. __ _ _ _
— — _ _ _ _ _ _ - Hazleton IN 47640 __
364
!key R/Kathy Belcher
6118 N Old US Hwy 41 State Parcel Number Legal Description
Hazleton IN 47640-9220
IIIIIIliiiiilletilluIIIItililii11Illllllll' Illnlllntll -1 00-000.040-018 010-00040-OO PT,NE 121117.852 AC
V 1 7.011 11
0.ai
PART 2:TAXPAYER iNFORMATION
Owner I First Middle Last
zsEy iNy B E. LQH E ft (SR)
t g Address(number chid street,city,sate,andZIP code)- — -- — — — — — _teal Same m propcny uddiess—-- — --
L01 Ig )3 01D Us HuV 41 H. I-ZL .T€ owl 2"N.bia N 4-740-9z4M
Spouse First Middle Last
R LC:C I (R1Hq . LDuISE . F >_c .)-1r- ►2
Mailing Address(Number and street city,state,and LIP code) ®Same as property address
b1,1% N\ 01-1 us \ ; ui\j, 4-1 HPs LLE 0 k TNbtAEIA 4-7(-04-0 -Q2?-6
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
+a CREDIT /STANDARD DEDUCTION HC10
( State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
g)D„ 1`` / K c- t_/.�YV.� ce �)jj1 tf1�1ti 4.day of March, 19�Y
occupied as our principal place of residence. the fol ing described real property f hich a Homest ro eRy Tta�c 'r4edit is hereby claimed:
el (We) owned ❑ Are buying under contract /p1,,,, Jr
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that ov4 fFie 5ro VN) ying under a contract.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'
PROPERTY DESCRIPTION
County
Township
Township
Taxing district (city, town, township)
Parcel number
L I description
11��
04
Sign rare of imam rj
�d�fYZi
_
If any portion of the residential structure or the land not exceeding one (1) acre that immedilj surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
ti
67 =d -am-
000.6 D e)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Greby certify the above statements are true, correct and complete.
Sign rare of imam rj
�d�fYZi
A dress (nurgher and street, city, state, ZIP code)
ox LP7o
ti
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
�ying action - Signature of Auditor
Date signed
STANDARD DEDUCTION
19_ Pay 19_
Lesser of 112 Homestead
Valuation or 52,000
461WEN1111 .
Date